Thursday, April 13, 2006

Abortion and RU-486

Something that almost always gets lost in the rhetoric regarding abortion rights in the U.S. is one of the root reasons so many people feel strongly about supporting those rights. Oh, to be sure, amongst the discussions of the pro-choice side of the debate is the kernel of this reason, but it's rarely brought up because pro choice advocates all too often cede the terms of the discussion to the anti-choice forces by discussing the alleged rights of a fetus. So, what's this reason?

Follow along: the dirty secret is women will get abortions. It doesn't matter if the law says it's OK or if religious leaders claim it's immoral. The fact of the matter is that throughout history - for thousands of years - some women have sought to terminate pregnancies. It's a fact and it happens and the result is that every year thousands of women around the world take a risk of having illegal abortions that result in mutilation and/or death. The real debate in the U.S. for a number of years was, well, while the morality of abortion itself is debatable, the fact of the matter is that women are getting them and dying every day because of it. Is the fetus' alleged rights (a debatable matter) any more important than a woman's right to life (a non-debatable matter). Women were getting abortions; women were dying. That was/is a reality and certainly one grounded on much more solid footing than the ethereal question as to whether or not a fetus had a soul.

The solution, while perhaps not palatable to everyone, was to stem the deaths of women. Set up clinics run by trained doctors and stem the tides of deaths that were occurring every year. That was an effective and obvious moral good and it gets lost all too often when the rhetoric is steered towards discussions of women's birth control choices.

I've been meaning to write about this point for some time. The South Dakota law was the inspiration for the post, but I was distracted by other issues. This morning, however, I was reminded of it because of an article in Reason magazine. RU 486 is under scrutiny again by this Republican Congress that seems to want to govern more by belief than science. In fact, the utter disdain towards science that's been demonstrated by these mimes is incredible. From global warming to Terry Schiavo to (un)Intelligent Design, these nuts have steadfastly held up beliefs that belong to a time that is several centuries old. Now, in order to impose their belief system, they are using the tragic deaths of a small number of women who used RU 486 as a method to thwart scientific reason. In a fine column, Kerry Howley dissects their line of argument. Of course, Kerry imposes science and that will be ignored by the Republamentalists:

Why accept any risk at all? As DeMint put it back in 2003, "If airplanes were as dangerous as RU-486 no reasonable woman would ever fly," and added that a woman is 200 times more likely to be injured or killed from the abortion pill than in an airplane crash. That's an interesting factoid about the safety of air travel in the U.S., but a woman weighing the abortion pill doesn't get to choose between Mifepristone and American Airlines. Given her options, a woman seeking a safer alternative to the abortion pill may well find that there aren't any.

Mifeprostone's manufacturer, Danco, states that 560,000 women have taken the drug regimen since it was approved in 2000. If Mifepristone turns out to be the cause of death in all five possible cases, the pill's mortality rate will be under one in 100,000. Between 1988 and 1997 (before the abortion pill was approved) the mortality rate from legal induced abortion, according to the Center for Disease Control, was 0.7 per 100,000. What do comparisons between drug-induced and surgical abortions tell us? According to Dr. David Grimes, former chief of the abortion surveillance branch at the Center for Disease Control, not much.

"I think this whole attempt to compare [abortion mortality] numbers is a fruitless enterprise," he explains. "These numbers are so tiny that the problem becomes enormous statistical instability."

While Grimes cautions against comparing abortion methods—mortality rates being "almost unaccountably small," reporting rates being uneven, and the causes of some deaths as yet unestablished—no one questions the heightened risks inherent in the remaining alternative: pregnancy. In 1997, the pregnancy-related mortality rate was 12.9 deaths per 100,000 live births; more than tenfold that of legal abortion.

Pregnancy was never deemed safe by FDA regulators (and presumably would not make the cut), but drugs more dangerous than the abortion pill have the agency's blessing. The Association of Reproductive Health Professionals cites a mortality rate of five per 100,000 for Viagra, the erectile dysfunction drug, and as Dr. Paul Blumenthal, professor of obstetrics and gynecology at Johns Hopkins University in Baltimore, puts it, "That's a risk men are willing to take to have erections." 150 people die every year from Tylenol overdoses, and the American Association of Poison Control Centers attributed 59 deaths to aspirin in 2003.

Abortion opponents believe all abortions to be deadly, so the conceptual leap to dubbing Mifeprestone a "killer pill," as the Concerned Women for America have, is but a hop. But if Congress's actual goal were to minimize maternal deaths at all costs, it would be bussing American women to abortion clinics in droves. That abortion is safer than childbirth is not a particularly good argument for its legality; the issue cleaves the cultural divide precisely because it cannot be reduced to statistics. The pill's relative safety should signal to abortion opponents—and, one hopes, the FDA—that abortion rights are better debated under the guise of morality than absorbed under the rubric of public health.